There are so many things wrong with the Baby Friendly Hospital Initiative (BFHI) that it’s hard to know where to start.

The very name is a deliberate slap in the face to women who can’t or don’t wish to breastfeed. While breastfeeding has some benefits, in industrialized countries with clean water those benefits are trivial.

There’s nothing particularly “baby friendly” about humiliating, harassing or inconveniencing mothers who want to formula feed or find that breastfeeding is not working for them.

The BFHI is potentially deadly. The emphasis on 24 hour rooming in, even for mothers who don’t want it, has given hospitals cover to close well baby nurseries. That has led to babies being dropped out of bed or smothered by mothers who fell asleep while holding or nursing their babies.

Neonatal hypernatremic dehydration, which occurs when women can’t make enough milk to fully nourish a newborn, may be rising as women are told (erroneously) that any formula supplementation, even temporary, is harmful to babies.

But the ultimate irony of the Baby Friendly Hospital Initative is that it DOESN’T work. Despite the expenditure of millions of dollars and countless healthcare provider hours, the BFHI doesn’t increase breastfeeding rates.

The BFHI is an abject failure on its own terms.

This fact has been known for some time. I’ve been writing about it for years, and the professional lactivists I’ve tangled with in print have not been able to rebut it. Now, however, a comprehensive review of the BFHI literature shows that, on its own terms, the Baby Friendly Hospital Initiative is a spectacular failure.

The authors are clearly partisans of the program. One can almost feel sorry for them as they desperately search for benefits from the BFHI and find almost none.

When taken as a whole, the majority of research included for review supports the BFHI as an intervention to increase breastfeeding initiation, long-term breastfeeding duration, and increased breastfeeding exclusivity rates . However, it is notable that most research did not support the BFHI as an intervention that improves short-term breastfeeding duration rates. In addition, there is only a small difference in the number of studies showing that the BFHI increases breastfeeding initiation rates and those showing that it does not have an effect on initiation (4 vs 3, respectively).

What the authors mean is that when developing as well as developed countries are included, the BFHI has small benefits, but when considering only industrialized countries, the BFHI fails in most of its stated aims. The only area in which it seems to be successful is in increasing breastfeeding initiation rates while in the hospital. But most of that increase disappears when women leave the hospital. Since the goal of the BFHI is to increase the proportion of infants who are breastfed and the duration of breastfeeding, this is an indication of failure, not success. Yes, the BFI can harass women into attempting breastfeeding, but it doesn’t convince them to continue.

The authors try to put the best possible face on the dismal outcomes:

Considerable heterogeneity in definitions, design, methods, analysis, and outcomes was noted among studies; thus, it is not surprising that the results also are heterogeneous. Although it is difficult to reach definitive conclusions about the effectiveness of the BFHI based on the variety of research efforts to date, some trends do emerge.

A majority of the studies that assessed the effect of the BFHI did find that the program had a positive influence on breastfeeding outcomes. Of note, however, is that an increase in exclusive breastfeeding in the hospital is a criterion for Baby-Friendly certification. Thus, concluding that the intervention increases breastfeeding initiation employs a circular logic because the intervention itself cannot also be a measured outcome…

The lactation industry decided, without any scientific evidence, that the reason for less than 100% breastfeeding rates was “lack of support” for breastfeeding. Then they mandated specific actions that they believed constituted support, in the absence of scientific evidence that those actions were either supportive or effective in promoting breastfeeding. They created a credential (the BFHI) to award to hospitals who complied with their recommendations, with a price tag of over $11,000 per hospital.

Not only did they provide no evidence that these recommendations work (lecturing mothers about the benefits of breastfeeding, making formula virtually unavailable in hospitals, intimidating women who asked for formula, refusing supplementation under nearly every circumstance, and enforced rooming in policies), they failed to provide any possible mechanism of action by which the recommendations were going to increase breastfeeding rates.

At no point did they ask mothers why they couldn’t or wouldn’t breastfeed. They did not ask mothers who had given up breastfeeding before they had reached their stated goals why they stopped. That’s not surprising because the Initiative was designed to benefit the lactation industry, not women and not babies.

Having monetized the provision of lactation support by becoming paid lactation consultants, proponents of the BFHI made a critical error. They confused what was good for them — ever more opportunities to profit — with what was good for mothers. They never asked mothers what they wanted because as lactation consultants they believed they knew better than women themselves.

The BFHI is a classic industry sponsored initiative masquerading (as most industry initiatives do) as good for consumers. It’s not good for mothers; it’s not good for babies; and it doesn’t even work.

It time to abolish the BFHI. Hospitals should continue to employ lactation consultants, but they should be there to support women who want to breastfeed, not to “educate” those who don’t. Most importantly, lactation consultants and the breastfeeding industry should have NO control over hospital policies with regard to formula supplementation, rooming in or well baby nurseries.

The truth is that breastfeeding is simply not beneficial enough to spend millions of dollars and the efforts of millions of healthcare providers to promote it. Those scarce dollars and provider hours should be spent providing healthcare, not support for the breastfeeding industry — not least because the BFHI is an abject failure on its own terms.

I’m a RN on a OBGYN floor. I hate “baby friendly” and we are not even fully designated yet. Are hospitals paid or get reimbursement for this? Why is this such a goal. I’m seriously considering leaving L&D because I can not get behind these standards we are trying to force on mothers. I work night shift and it’s even worse trying to enforce these guidelines at 3am when an exhausted mother is desperate for a pacifier and has been cluster feeding for hours and I’m supposed to say no! It’s crazy!! In a time when everything everywhere is all about people being free to think, act, and be whatever they feel is right we are going to try to control something so huge as to how a mother feeds and cares for her child? Where is her rights?!?

Thanks, Liz! It was a very interesting reading, although an infuriating one.

“Engaging with anti-vaxers may help you understand how to do medicine better.”

Sounds nice. Only, it doesn’t. Understanding how to do medicine better, I mean. Overwhelmingly, doctors report that they can rarely change the anti-vaxers mind by engaging with them.

Doctors, pharma and government have too much authority over people’s kids? Why don’t people take their kids and go off in an internet-hot water-whatnot-free cave? There, they can happily have all the authority they demand over their children. Living or dead. Just like it was before evil authorities took over. Parents had all the control they could want, from watching their child die due to stepping on a nail to choosing the outfit children would be buried in after they died from preventable diseases.

Too much authority? I thought that was called living in society.

Same old, same old. Be nice to anti-vaxers! They’re just concerned parents! Sorry, no. The hardcore anti-vaxers are immune to reason. Nicety and engaging with them don’t help. What does the author suggest? He doesn’t say it directly but he seems to be against a law prohibiting disease-vectors from attending public schools?

Just like always. Cater to the ignorance. Accommodate it even when it’s dangerous to both its own kids and other people’s kids. Just don’t be so dogmatic!

Barf.

AA

Some time a last months, a commenter linked to a JAMA Peds article from the 1920s that may explain teh whole “a newborn’s stomach is the size of a cherry” thing. Anyone have a link to that post?

ETA: I feel sorry for this mom. Sounds like she’s putting herself through hell.

Madtowngirl

Another example of why we need to stop moralizing breastfeeding. Perhaps if “breast is best” hadn’t been drilled into her head, she wouldn’t have been so devastated when her daughter needed something else.

Amazed

She seems quite aware of some facts. This mention of support that she received as a nursing mother and lost together with nursing cut straight to the core. She didn’t just lost her confidence that she was doing what was best for her baby – she lost the support she needed and that’s a vile thing. The whole hypocrisy of supporting breastfeeding mothers comes to light. What does “supporting breastfeeding mothers” even mean? Encourage them to pump, pump, pump? Pat them on the head when they have no trouble with it? Accosting strangers in the bus to tell them how great they were for feeding their child from their naked breasts? But when a breastfeeding mother needs support more than ever – oh just come and see how support is withdrawn. It’s breastfeeing they support. Sure, they support breastfeeding mothers, as long as the sacred goal is breastfeeding. Once that’s out of the cards, you’re out in the woods. On your own.

Young CC Prof

That is the worst thing about the breastfeeding “support” movement: It’s conditional. It takes support away from brand new mothers for something that’s often entirely beyond their control: Whether they can breastfeed.

Amazed

Actually, her case shows that it’s worse! She could and did breastfeed. She clearly wanted to and did it for a long time. But the moment it became dangerous, the support went back, despite women knowing and seeing that she was going through hell and yes, that she HAD breastfed and WOULD have gone on breastfeeding. They don’t care WHAT the problems are. As long as they put their precious breastfeeding in jeopardy, you’re on your own with your new problems and the problem of THEM as well.

Azuran

Seriously. The breastmilk almost killed the baby and they are like: ‘Breast milk is still the best for her, don’t eat this ridiculous list of food and hopefully it won’t kill her’

When I developed a serious allergies to breastmilk, they gave me formula without any second thought. I turned out just fine. I even outgrew the allergy, I’m totally allergy free, I’m not even lactose intolerant.

Amazed

Poor woman. It’s downright terrifying how she took the almighty line of “breast is best” hook, line and sinker, to the extent of pushing down her reasonable doubts – that putting other woman’s bodily fluids into a baby might be a little over the top – just to feel helpful and not useless because breast is best! If not for her own baby, then others!

The grandmother in the story should be flogged. Instead of helping her daughter come to terms with the fact that she didn’t have milk, she whine-whined and then rushed to take a freaking STRANGER’s bodily fluids to pour into her grandchildren’s. Notice that the doctor didn’t say “other women’s breastmilk”. They were talking about the mother’s own milk (bad enough but still”.

guest

I asked a nurse about milk bank milk for my preemies, and was told it was illegal. I don’t think it is illegal in my city/state, but it was clear that my hospital was NOT going to authorize milk bank milk for my preemies. It didn’t matter for us in the end.

For very young preemies, breast milk seems to prevent NEC. It is important, for a time. But no, that doesn’t mean getting milk from a stranger.

BeatriceC

I never looked into it further, but I was told by the NICU where my youngest was born that breastmilk produced by the mother is actually different depending on the gestational age. I don’t know if that’s true, but if it is, it throws the whole milk bank option out the window.

guest

It does, but there’s all this yammer about saving the milk screened by certified milk banks for preemies. And for micropreemies, many mothers have difficulty producing milk. So who knows.

Amazed

“Now I wonder why we don’t all do this.”

Because there are milk banks? Because it’s 2016 and if women want to donate milk, they don’t need to do it the old-fashioned wet nurse way? Because disease transmission could be avoided by going to an actual milk bank and not just saying, “Oh I was tested, it’s A-OK!”

FFS, if the queens of old knew what we know now, they’d have been the first ones to insist that wet nurses got all the testing… and not rely on their oral reassurances. Same with other mothers. They weren’t doing this because they thought other women’s informally received breast milk was so much better than formula. They didn’t have formula. They were just trying to save their children’s lives.

Shared nursing? A lawyer mother of a 5 year old wondering why more women won’t do that? What?

Azuran

It’s not like they could have easy access to the baby. A gorilla mother is nothing to take lightly, if she decides that you are a danger, she can easily kill you. And tranquilizing her repeatedly to get access to the baby is not a viable solution. Sedating wild animals has a lot more risk than human anesthesia, The stress of it all could make her abandon the baby or become aggressive, It could affect milk supply either from the stress or the drugs (which could also pass into breastmilk and affect the baby)

D/

Absolutely! The idea of “intervening” with a gorilla mother makes me cringe and very thankful that’s not a piece of my puzzle in figuring if babies are fed.

It’s a shame though with remote viewing being such an important piece in their feeding assessment plan that she could turn her back to avoid the cameras and delay their decision of when to intervene. Definitely a hard job, and I’m certain a sad day for all involved.

D/

Oh, and after re-reading Gatita’s leading comment on her zookeeper story more carefully, I’ll add that much of the human lactivist nonsense (in particular the let’s-not-weigh-babies-for-the-first-day solution) absolutely wins the not-smart contest all around.

The sad little gorilla story is an example of not always figuring out whether breasfeeding actually going well. There’s NO excuse for avoiding the assessment of whether our human babies are fed and intervening when they are not … ever.

When [the cheetah] was two weeks old, animal caretakers at the MRZ noticed that he wasn’t gaining weight. In fact, he was losing weight, making him the runt of his litter. We removed the cub to bottle-raise him, with the hope of being able to boost his weight, and then eventually reintroduce him to his family.

However, we discovered that his mom, Khari, was not producing enough milk for her three cubs. Only 2 of her 8 nipples were functioning, so zoo staff decided to keep hand-raising the cub to ensure his health and growth.

Anne Catherine

Being OCD on this subject, I just read that study and I’m a little annoyed–
It says in the Intro,”

“……a large body of evidence documenting the many benefits of breastfeeding for both infant and women.[1] Infants who breastfeed for 9 months or more have 30% lower odds of childhood obesity compared to infants who were never breastfed.[2] Breastfeeding has been associated with a decreased risk of otitis media, atopic dermatitis, gastroenteritis, severe lower respiratory tract infections, asthma, types 1 and 2 diabetes mellitus, childhood leukemia, sudden infant death syndrome, and necrotizing enterocolitis.”[3]

This is so typical —the reference for a 30% reduction in obesity is from 2005
(which was the last study that found results like this), and the reference for the rest is from 2007 (which cautions that these are associations not causal relationships–and said that the 2005 obesity study wasn’t well done). And as we all know, almost all recent research on the rest does not find BF protective for eczema, asthma, obesity, diabetes–and is somewhat mixed on the rest.

It would be interesting if they studied whether rates of these conditions are lower for kids born at Baby Friendly Hospitals. I just wrote the author to see if they know of anyone who looked at those outcomes. (which is what researchers should really look into –if this has any health effects on the babies–besides maybe higher rates of admissions for dehydration!)

sdsures

“The BFHI is potentially deadly. The emphasis on 24 hour rooming in, even for mothers who don’t want it, has given hospitals cover to close well baby nurseries. That has led to babies being dropped out of bed or smothered by mothers who fell asleep while holding or nursing their babies.”

I live in the UK. A FB friend of mine (also from here) insists that it “just doesn’t happen”, ie that we have a lower rate of mothers harming their babies here.

She hasn’t backed up her claim with anything.

rh1985

maybe mom is less likely to accidentally fall asleep if she’s in a room with three other mothers and their crying babies… in the US it’s almost all private rooms unlike the UK?

Sarah

True, there’s not much falling asleep going on in communal postnatal wards in the UK.

sdsures

Thanks for all the replies. I dont have the energy to fight with her at the moment because there’s a pretty big crisis going on in my family across the pond. Nobody saw it coming. 🙁

Dr Kitty

Goodness.
Hoping for strength for everyone in a difficult time.

Dr Kitty

With #1 I was in a six bedded bay of a 48-bedded ward.
Of the twelve women in my bay and the one on the other side of the corridor, only me and the lady directly opposite me were breastfeeding.
Everyone else appeared to be able to sleep, despite the crying babies.

One of the older midwives, presumably not realising I was breastfeeding, offered me a sleeping tablet and assurances that they could wake me every four hours to feed the baby.
Hard pass from me but clearly there were some takers.

Second baby- private room and much better quality sleep, for both of us.
Although the second night the last Terry Pratchett book was released at midnight, so any lack of sleep can be blamed on reading (and very emotional reading) rather than my newborn.

Sarah

From what I’ve heard, the worst conditions are in south east England.

I was very fortunate that with both of mine, the midwives cared for them overnight so I could get sleep, but the postnatal ward was simply far too much for me after no 2 (EMCS, baby in special care 48 hours). I had a private room while baby wasn’t with me, but once she was out they put me back on the ward and there was no way I could cope in there. I think you have to be feeling quite psychologically robust to manage with so many people and noisy babies and visitors in such a small space, and I wasn’t. Fortunately, they found me another private room when it became obvious I was going to lose my shit.

There have also been some articles about SUPC, which can happen to healthy newborns. I don’t have time to look to up now, but I think it happens during skin to skin –babies can get too cold, and it’s not a good thing–

Anne Catherine

Okay —
Here’s a link to an article about Sudden Unexpected Postnatal Collapse—

Lots of us, including myself, use Macs. I’d be happy to answer questions about them, if you’d like. There’s some differences between Macs and PC’s that aren’t difficult once you figure them out, but aren’t exactly intuitive.

PS: I have to ask MrC Windows questions practically every time I use his computer. It’s one of two non-Apple products in the house. The other is an Android tablet I also have no clue how to use. I did use a PC when I worked for a major US bank, but that was I don’t even know how many operating systems ago.

Anne Catherine

Thanks!! I’ll keep this in mind!

somethingobscure

PREACH.

momofone

OT, but I just saw an official confirmation of the death of a 13-year-old girl not far from where I live. She died of flu, and her younger sibling is now sick as well. Such an awful thing, and it made me think of the terror families must have faced generations ago in similar situations. 🙁

CSN0116

When I look back at our family records there are so many babies and children lost before age 5. We have a lot of “mourning photos” from the same time period (which are morbidly fascinating, by the way). Those poor parents. All they could do was pray and wait for the inevitable, totally helpless to stop their child’s suffering. I cannot even imagine. We are so fortunate to be living in modern times. And to think people would rather throw this all away for conspiracy.

Gene

I ask people all day long if they are up to date on their vaccines. They almost always respond “Yes!” But when I ask, “Flu, too?”, they respond, “Oh,no. We don’t believe in the flu vaccine”.

I’ll never understand why people think of the flu as a mild disease.

Madtowngirl

My husband used to refuse the flu vaccine. Then he got H1N1 and Type A in the same 6 month period. I almost had to take him to the ER, his fever got so high. He gets it every year now. The flu is not mild, by any means.

BeatriceC

I’m medically contraindicated from the flu vaccine. Everybody else in my house gets it and I have to hope that’s enough to protect me.

Roadstergal

It’s not just that they don’t get it, it’s that they act so _superior_ for not getting it.

AA

I’ve heard people say “I’ve never gotten the flu and I’ve never gotten the flu shot, so I must be doing something right, right?”

Roadstergal

Or “I got the flu shot, and then I got the flu.” Followed by a description of symptoms that sound just like the common cold.

cookiebaker

Oddly enough, I’ve never had the flu and never got a flu shot for many years. I was vaccinated as a kid, but my parents never got us flu shots, so I just never knew a person should get them. My husband gets them through his work and I have the kids done at the pediatrician, but I never get around to getting mine (unless I’m pregnant, then I get it.). The flu has gone through our house several times, despite the vaccines. I’ll be knee deep in sick people and don’t get sick. As much as I’d love to be a spechel snowflake, I know it’s just luck. I need to get better at getting my shot! I’m sure there’s a flu strain out there with my name on it and I don’t want it.

Dr Kitty

Gene, you know why.
Because they had a bad cold once and diagnosed themselves with ‘flu, but they got better in four days.

I tell patients that unless they have ever had a cold that put them on their back for three weeks and made every inch of their body ache, they haven’t had ‘flu.

Like the people who insist on antibiotics for every viral cough who finally get a bacterial pneumonia and realise that the “chest infections” they had before were nothing.

Bugsy

I did have the flu two years in a row when I was in middle school – it was pretty much exactly as you describe, and left me with a wicked bout of bronchitis following it. I’ve since gotten the flu shot every single year (going on 21 years now), and never had the flu again. That’s why we’re also religious about our boys getting the shots. Kiddo #2 is too young, so you can bet I got the flu shot as early as I could in my pregnancy with him.

demodocus

i’m nervous about my kid #2, who won’t be 6 months until December

Bugsy

I understand…our #2 will turn 6 months in May, so no flu shot for him this season. Hopefully it will be a late flu season in your area next year.

demodocus

thanks; we hope so too

Madtowngirl

My baby was 6 months at the end of last December, and they were still able to give it to her. Doesn’t help much if the flu starts early, though. :/

demodocus

that’s what we’re planning, but as you say, it could come early.

Are you nuts

I used to be more nonchalant about getting the flu shot. If they gave them in the office and I was there, I would get one but wouldn’t go out of my way. Then one year I got the flu. It wasn’t three weeks, but it was a solid week of being too sick to get out of bed. Never missed one since.

indigosky

I got the flu a month ago and am still messed up. Still need sleep and am too weak to do much more than go to work. These people have obviously never had the flu. And if I don’t get the shot, it can set me back 3-4 months.

Kelly

I thought I had gotten the flu a few times because I threw up or I got a bad stomach ache. I really had no idea that was not the flu until I got to this site. I do not think I have ever gotten the flu or my children but I am up to date and I made my close family members also get it because I am not willing to make my infant sick or risk having my husband off of work for several weeks.

Amy M

I got the flu 5yrs ago (I did have a flu shot, but it wasn’t so effective that year, I guess). That’s the sickest I have ever been in my life–the flu itself was relatively mild, but I have asthma, which went on and on for weeks, until finally I got pneumonia, an ear infection, a sinus infection and pleurisy all at the same time. I’m a big fan of flu shots anyway, because I know the shot had nothing to do with that nightmare, it was just bad luck + asthma.

Mishimoo

My husband used to not care about the flu vaccine “because I don’t really get sick, and everything clears up in under a week.”

Then he was laid out for 6 or so weeks one year, and had several doctors visits. Now he nags me to find out when the new vaccine will be released so we can get it asap.

Bombshellrisa

Because they have never had to be the one to run a code and call time of death on a baby who died on their first birthday of the flu. Our pediatrician has. She told us that story when we were asking about the earliest time our child could get the flu shot.

Amazed

When I went to have my flu shot, I emerged to a waiting room full of people who stared at me as if wondering where I’d hidden my extra head. They seemed to be waiting for me to drop dead on the way to the door. Because no one should have NEEDLES and POISONS unless absolutely necessary and anyway, it’s just the flu!

PrimaryCareDoc

This doesn’t surprise me one bit. Medicine has a nice recent history of jumping on policy bandwagons without any evidence of patient benefits (and spending potentially hundreds of Thousands of dollars to get bogus “certifications”). One of the biggest boondoggles is the whole Medicare Meaningful Use initiative, which basically forced all doctors to adopt and use electronic medical records and meet a bunch of arbitrary benchmarks. The head of CMS just basically admitted that the program was a collosal failure and is being scrapped. The Patient Centered Medical Home is another.

Azuran

I’d agree with the use of electronic medical records. After another vet in the area retired, we bought her clients. She had handwritten medical reports. We cannot read a single word of it. So we keep having her clients coming in wanting their prescription filled or coming for follow up in their pet’s medical problems and we cannot figure out any of her horrible handwriting. It’s a nightmare. (of course, they cannot remember the name or dosage of the medication, nor what illness their pets actually have) Same when we have referral of other clinics with handwritten records. It’s unreadable.

But unfortunately they tend to overdo thing. Instead of letting each hospital pick the already existing program is most appropriate for their own use they spend billions making a whole new ridiculously complicated program and force everyone to use it.

PrimaryCareDoc

I have no problem with the use of EMR. My problem is with the pointless benchmarks that have to be met while using it, all in the guise of patient safety while no evidence for improved outcomes exists.

Young CC Prof

It sounds to me, on the outside, like EMR is a necessary and potentially very helpful thing, but when the systems were actually built, they were more designed to serve policy makers and insurance companies than doctors and nurses.

PeggySue

In principle it’s grand. In actual fact it’s a pain in the a $$. The ones I have seen are cumbersome and poorly designed and become more cumbersome as additional reporting requirements are added. Depending on implementation they can be hilariously inaccurate. Often a nurse has to enter the same information more than once because the system is poorly designed, or use multiple screens that each work differently (use a different key to start a search, for instance) making the work unnecessarily complex. Typically it is hard to impossible to get custom reports out of these things unless you’re in very senior management, so I am dealing with trying to manage a caseload of over 100 patients and have had to develop a parallel manual system because the EMR does not help.

Young CC Prof

Ah, impossible to get custom reports. We get that at our community college, too. I don’t have access to any of the screens that give really useful reports, so I can either put in a request and wait weeks to get something that might or might not be what I asked for, or spend several hours doing a records search manually. I have done the latter more than once.

Madtowngirl

Ironically, one of the big EMR software companies is in my hometown. So, of course all of the local medical facilities use their software. I’ve never heard a positive comment about the software, even from the developers.

AA

In fair Verona, where we lay our scene

Madtowngirl

Lol, well hello neighbor. 😀

Dr Kitty

The problem with NOT having set standards for record keeping is that you get situations like the single handed Irish GP who kept his patient files literally on the backs of envelopes, because he had an excellent memory and had memorised everything of importance. Only his son joining the practice as a partner led to patients having actual files…not joking.

When someone changes GP we get all their old records. Then we have to summarise them. Easy for the last 15 years where everything is a typed printout. Less so for the 1960s where I’m trying to decipher a faded ink scribble.

AA

You could hire me as a consultant. I am notoriously good at reading bad handwriting. It takes one to know one…

BeatriceC

I taught middle school math for years. There’s not much I can’t read.

MaineJen

EMR are a great idea in principle…in practice, each and every single hospital has a different computer system for ordering and resulting tests, and a separate system for medical records if you’re really unlucky. Oh, you want all these computer systems to actually be able to TALK to one another? That’ll be a hundred million dollars, please. I wish I was joking.

Madtowngirl

This isn’t really relevant to the paper’s findings, but why do health professionals fail to address risk factors for being unable to breastfeed prior to a birth? Is this also part of BFHI? It was a lactation consultant who pointed out that I had multiple risk factors (infertility, inverted nipples, no change in breast size during pregnancy) for being unable to EBF. My daughter’s pediatrician alluded to these factors, too, so it’s not like they are unknown.

I have to wonder if OBs or hospital nurses are being told they can’t say anything because it might “discourage” breastfeeding.

CSN0116

I feel that mental health should play a large role here too. Being forced to be the only one who can feed your baby, putting yourself in an exhausted state, can be catastrophic for some women’s mental health. Not to mention those who want/need to continue certain medications but are willing to stop them in the name of breast milk.

Gene

It’s almost like the evil eye. Don’t talk about problems with breastfeeding or they might happen to you!

“The practical implications of this study are to emphasize the importance of building up positive attitudes in the mother toward breast feeding if an abundant milk supply is desired. It is not enough to educate the mother into saying ‘They say breast feeding is better,’ because such mothers failed to have enough milk. The attitude must be a more positive one than this and must involve the mother’s personal feelings. The mother who spontaneously said: ‘I am going to breast feed,’ ‘I’d love to breast feed,’ usually had abundant milk. Unless women can be educated to desire wholeheartedly to breastfeed, the evidence cited here indicates that they will probably fail to have an adequate milk supply when they attempt to breast feed.”

In summary, there is long history of research suggesting that women’s ability to breastfeed is tied to her attitude about it. If they told a woman her baby is at risk for insufficient nutrition and that she needs to be carefully monitored, it would be a self-fulfilling prophecy some fraction of the time.

Madtowngirl

Thanks for pointing that out. You’re probably right.

But then I have to wonder about the implications regarding giving proper information to mothers who wish to breastfeed. Sure, their attitudes may affect the outcome – but there are many sad stories of women who were determined to breastfeed, and their babies became very ill because they weren’t producing enough.

I personally think my mental health wouldn’t have suffered as much if I had known that there was a real risk that I wouldn’t be able to breastfeed exclusively. At the time, it was yet another way my body was failing me. I may have been better prepared for that outcome if I had known my risks.

Valerie

Sorry from being unclear, but I think it’s wrong to keep a woman in the dark about her health and her child’s health so that she would be more likely to attempt to exclusively breastfeed. That experience sounds pretty awful, and I’m sorry that it happened to you. Even if attitude were the sole determinant of milk production (I’m not convinced it’s causal at all), it still wouldn’t justify manipulating women through selective “education.”

crazy grad mama

Lactivists and NCB folks always seem to describe a vision of hospitals that’s 50 years out of date when they push for these kinds of changes. Yes, it was good for medical professionals to legitimately support breastfeeding, rather than assuming that most women want shots to dry up their milk. But we made that change three decades ago.

My theory on why the BFHI doesn’t make much difference is that hospitals only matter for breastfeeding rates if they’re actively discouraging it. Once they’re not, all of the other, longer-term factors matter more.

swbarnes2

Right, part of the problem of this paper is that most of the policies of BFHI are being carried out by non-BFHI sites; same policies, same outcomes. So of course they aren’t seeing a strong difference. Once you get LCs into every hospital, I doubt there are any other policies that are going to make much difference on top of that, and following a few extra policies so you can buy a designation isn’t going to change that.

Young CC Prof

Most of the policies that actually matter are being carried out at all hospitals, like having staff members help with breastfeeding and allowing mother and baby to be together as much as is practical. The other “baby friendly” policies seem to make no difference.

Sarah

I would have liked to actually be offered a shot to dry up my breastmilk. That choice seems to have been taken from us.

Kelly

From what I understand of the shot, it has a higher risk of women getting breast cancer.

Amy M

From the shot itself? Or from the lack of lactation and its interruption of cycling/hormones? (genuinely curious, not being a facetious jerk)

Kelly

From the shot. I read it awhile ago so I have nothing to back that up with.

rh1985

There’s a newer medication (I think it might be pills instead of a shot) that’s used in some other countries but not available in the US. Seems FDA doesn’t want to consider it because of the problems with the shot, even though it’s an entirely different medication. I’m relieved my milk just never really came in at all because I was worried it would be awful.

Kelly

That would have definitely been nice as I never started nursing this time and seem to still have milk five months later. Overall, it was not that bad for me. It was three sore days and then most of it went away. I think the pills would be great for those have lost a baby though. Nothing like reminding you that you came home without your baby like dealing with your leaking breasts.

rh1985

I leaked a little bit, but those must have been the only drops I produced, because I had zero pain or engorgement.

Sarah

Which is fine, but so does the combined oral contraceptive pill I take. I would still like to have been offered the choice. Forgive me for having my doubts as to whether this apparent increased cancer risk is the main reason it’s no longer routinely offered.

Kelly

I would not be surprised if there were another. As I said, I read it somewhere but don’t remember the source so I could have remembered wrong. I know it was not offered to me this last time.

indigosky

You know why most women I know didn’t breastfeed? They had to return to work a week (!) to 12 weeks after birth. Even in jobs where pumping was encouraged, they still didn’t want to because they didn’t want to be looked down upon by co-workers for taking all those breaks. If they want breastfeeding rates to go up, the only way is paid maternity leave for at least six months.

Madtowngirl

At my previous job, we had a mother who needed to pump. She was bullied and harassed until she decided it was no longer worth it. But that company loved to boast about its “mother rooms,” which had to be reserved in advance.

Dr Kitty

The UK has paid maternity leave, BFHI policies up the wazoo and really low rates of BF beyond six months.

There is more to it than that.

nomofear

Maybe, just maybe, constantly being nannied into doing something as if we’re small children makes us react like teenagers by refusing to do the thing altogether.

indigosky

I am in no way implying that that is the only reason. But they are clearly putting the cart before the horse when it comes to the US. They have zero real hope of raising breastfeeding rates without paid maternity leave.

But I forget, per lactivists, we are supposed to stay home with the kids, not work like good little housewives and attachment moms. Unless we are LCs ourselves, the only acceptable profession.

Sarah

Duh, CPMs can take their kids to the birth too.

Sarah

Definitely. The mat pay isn’t that generous, but the vast majority of women take leave for at least six months. Our problem, though, isn’t the low rates. It’s the number of women who did want help breastfeeding and couldn’t get it.

Azuran

Pumping at work is practically nonexistent where I live. I know no one, and never heard of anyone who did it or even considered doing it. All thanks to paid maternity leave. All put together we can get up to one year. Every single mother I know stopped breastfeeding long before they came back to work, and most did for more than 6 months.

I can’t believe those things are still happening. Refusing medical care to yourself because of your own religious belief is your choice. But under no circumstances should those affect the medical care of other people.
How do you think people would react if Jehovah’s witness opened up hospitals where they refuse blood transfusion to all of their patient, regardless of the patient’s wishes? Oh, you had a car accident and are in critical condition? The ambulance brought you to a Jehova’s witness hospital because it was the only one around? You need a transfusion to save your life? You are not a Jehova’s witness? Well, sad day for you, we don’t do those because of our religious beliefs.
No way in hell we would accept that.

Megan

And no way would this be accepted if it were men’s lives put in danger this way.

Azuran

I didn’t want to make this strictly about gender. But let’s be honest, we all know that’s the case.
I wonder. Do christian hospital refuse vasectomy? In case of testicular cancer, do they wait until the testicle lost 100% of it’s sperm production before they remove it?

Valerie

Directive 53: Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.

So, yes, they refuse vasectomy, but no, they would not prevent removal of a cancerous testicle (provided a simpler treatment is not available or, I presume, the other testicle still functions).

Azuran

and yet they wait until a women is is sepsis to induce a miscarriage. It they wanted to be fair about this, they’d have to wait until the man has metastasized cancer before they do anything about it.

Valerie

I’m not defending them, but there is Catholic reasoning behind all of their policies. It is completely logical and consistent only to men who never had children and spend all of their time reading scripture and imagining what God’s plan is for the world. It’s not about being fair- it’s about saving their own souls by preventing abortions at all costs.

demodocus

I once saw a video meant to encourage boys to become priests. I mentally shrugged at most of it but the part i really had to restrain myself over was where a young priest happened upon a car accident. He got out, looked at what happened, then grabbed his Bible and his purple stole and rushed to the accident just in time to give the poor kid last rites. It looked like a cheesy version of a paramedic recruitment video.
Dunno if i’d have been able to contain myself if I’d gone with the women teachers and the girls rather than with my male mentor teacher. They got a video about the awesomeness of becoming a nun.

MaineJen

It’s hard for me to believe that, in 2016, we are still letting (forgive me) fairy tales dictate medical treatment. The idea that a doctor would have to consult with a member of the ethics committee (usually a priest or nun??) before providing lifesaving treatment is not just abhorrent, it’s absurd.

Liz Leyden

If these women needed care that the hospitals could not or would not provide, why weren’t they immediately transferred to hospital that could?

swbarnes2

A lame attempt to hide their horrible policies? Women can’t complain about getting substandard care if they can’t see what proper care is.

Related link (trigger warning, the pregnant women all survive their miscarriages, but some of the stories are pretty hairy)

I’d guess because it’s not about the women’s well being. It’s about Christianity and abortion. It’s kinda pointless to say that abortion is an unforgivable crime and then transfer to another hospital to have it done.

indigosky

You are assuming there is. The Catholics are buying up hospitals like tyry are going out of style. In some areas it is becoming the only option within an hour or two.

Gene

What is so bizarre to me is that in the ED (and most other departments in the hospital), we have protocols in place if we think a patient MIGHT BECOME septic. Certain criteria (elevated heart rate, high or low BP, certain pain scores, respiratory rate, certain lab values, etc) trigger an alert and we have to recheck the patient. It gives false positives all the time (anxious babies with high heart rates, elevated white blood cells after a seizure, etcetcetc) that are NOT sepsis, but we must still check and document why we think it isn’t sepsis. That’s because sepsis can kill you quickly. You want to treat ASAP.

So here is a hospital who MUST WAIT FOR SEPSIS TO OFFICIALLY COMMENCE before starting treatment. They can’t do anything unless sepsis is present??? This may actually be a JCHO violation (hospitals can be fined or closed if they fail some of these published benchmarks). But they can get away with it because, what, “muh religion!”???

Sue

Yes! Same where I work.

It must be because the risk of giving antibiotics and altering that poor little gut microbiome (which is highly changeable until established on solid foods anyway) is worse than the risk of going into septic shock or dying of sepsis.

Young CC Prof

We need to pass a law that any hospital that accepts public money needs to comply with AMA reproductive ethics, not the peculiar ethics of their own religion.

What blows my mind is that we have so little actual research into the mechanics of breastfeeding. There are so many women who genuinely want to breastfeed but can’t and we have nothing that we can give them aside from try harder and weld a pump to your chest. It is almost like the end goal is making women feel like shit and not getting breastmilk into babies.

Amy M

It’s definitely easier and less expensive to just insist that 95-99% of women can breastfeed, if they want it enough and have enough “support,” than to do research into the actual reasons breastfeeding doesn’t work out. Physiological as well as social reasons, I mean.

LaMont

Of course if difficulty breastfeeding doesn’t have a major medical effect on children (or indicate deeper medical/psychological concerns for mothers that may require addressing), maybe hop over that step and instead combat the bullying surrounding the “failure” to breastfeed (which would probably be even harder/more expensive).

AirPlant

It is crazy, but I feel like the lactivists actually have a point about the lack of research surrounding human lactation. It is 2016 and we don’t have any legit pharmacological treatments for low supply. We don’t even have an off switch for women who have no interest in breastfeeding. We have mothers who want to breastfeed and who are killing themselves to make it happen and we have women who have to google how to dry up, and the best our medical establishment can give them is try harder. That feels like insanity to me.

Megan

“We don’t even have an off switch for women who have no interest in breastfeeding”

Sudafed can help.

demodocus

I”m going to have to try that; last time i only stopped lactating when i got pregnant again, 53 weeks after he was weaned.

guest

It may not work for everyone, but when allergy season hit Benadryl tanked my supply. I’m not sure which of the active ingredients does it, but I was taking psuedoephedrine.

Megan

I had a friend whose milk supply tanked for an entire week from one dose of Allegra. Antihistamines certainly can affect supply.

rh1985

I took daily pseudeophederine in Allegra D (OB approved it for pregnancy due to very severe sinusitis) and my milk, as far as I know, never really came in. I had very light leakage for a while, but zero engorgement and zero pain. So no idea if I even could have BF. I didn’t try because I had decided formula was the best option for us.

indigosky

That is true. We need real breastfeeding research, what all causes women to not be able to produce milk.

Megan

There is minimal research being done. The answers are not going to be easy fixes, I don’t think. I think PCOS and insulin resistance is going to be a biggie; they go hand in hand with our obesity epidemic and the fact that we have older, less healthy moms (particularly older first time moms). And I think now if they really studied the true incidence of women who make no supply or insufficient supply, the 5% number would be not even close.

fiftyfifty1

Yes, I think a lot of it is due to demographics. I was talking to the daughter of a dairy farmer yesterday. She mentioned that cows often don’t produce really well with their first calf, that it’s after the 2nd calf that production really kicks in. And then mentioned that milk production is known to drop off with age. So we know it about cows, but we pretend it doesn’t matter with humans. The average family is now 2 kids. So that means that about half of kids are first babies, and many moms who really want to breastfeed are older. So we have first time, old moms and many don’t produce well. Who could have seen this coming?(answer: dairy farmers!). Too bad nobody is studying human lactation with a non-biased, non-ideology-driven eye, the way they study it with cows.

DiomedesV

Cows are artificially bred for milk production. So milk production is clearly heritable. I can’t imagine lactivists admitting to such a heresy in humans.

Actually, they mainly are artificially bred. The young woman I was talking to told me that her family used to “have a dairy farm” but now that her parents are semi-retired, they just “breed dairy cows”. Their main income is now bull sperm for artificial insemination.

DiomedesV

Yeah, I meant either you’ve bred or you haven’t… but it was late. My point was that milk production in mammals is heritable and that human societies have explicitly recognized that for centuries.

Roadstergal

To be fair, there’s a decent amount of ongoing research about the NEC-protective substances in breastmilk, as getting them into preemies can be a life-or-death thing.

CSN0116

At what age does breast milk stop being beneficial for premature/preterm babies and their threat of NEC? I had 36 week-ers and nobody batted an eye at my decision to EFF. Just wondering…

BeatriceC

I’d guess the closer to term you get, the less the benefits are. They were pleased with no strong emotion with my 36 weeker, very happy with my 32 weeker, and practically falling over themselves with joy with my 24 weeker. Of course, even with that, there’ co-founding factors. My oldest was born in NC and the other two in FL. The two born in FL were born in different hospitals (though run by the same system). Middle kid stayed at the NICU in the hospital where he was born. Youngest was stabilized and transferred to a specialty children’s hospital a short distance (like less than 10 minutes) away. So it could have been the gestational age, but it also could have been different hospitals.

CSN0116

I just wanted my 36 weekers fatter as soon as possible lol. That and I have no interest in breastfeeding. It worked. They gained weight like crazy the first few months.

BeatriceC

Whatever works for you! Honestly that’s all that matters. A happy mother feeding formula is, in my non-expert opinion, better than a mother who’s breastfeeding but miserable and resentful of her baby.

CSN0116

I think a lot of it is a bi-product of post-industrialization and the new mobility of families. It defies nature for a woman to leave all the family she’s ever known, move across the country with only her husband/partner for a job/school, give birth in a hospital across the country, and go home to only a husband/partner who will be returning to work in 1-7 days. There are no sisters, no mother, no grandmother, no assistants. Just a stressed out new mom and a baby – isolated.

And then there are those women who are surrounded with some sort of care system, or who can afford to purchase it, but vehemently reject it because lactivist rhetoric has told them that a real woman can “pull herself up by her bootstraps” and just fucking get it done. There is stigma in even choosing help. That level of stress and isolation has to effect a milk supply, immensely I would assume.

I suppose you could circumvent this not with pharmaceuticals but with home care providers. But that would mean two things (1) women shut up and accept the help for what’s it’s worth, not see it as an attack on their abilities, (2) a lot of $$$.

BeatriceC

I think we need another situation like JFK. There was almost no research into the care of preterm babies until Jackie gave birth to a preemie that died. All of a sudden, research into saving the lives of preterm babies was a lot more easy to fund. Maybe if we got a president who’s wife was physically unable to breastfeed while her husband was in office, there’d be a national outcry to find out why.

CSN0116

Trump’s wife is of childbearing age, right? Isn’t she like 23? LOL

Young CC Prof

They’re right, but at the same time it’s kinda their own fault at this point. There is an Academy of Breastfeeding Medicine. There are journals of lactation. There are even research grants, although not a lot. And we still lack some really basic practical information about human lactation. Why is that? Because the supposed scientists doing lactation are instead wasting their grants on ideology and the 5,000th useless study of the health benefits of breastfeeding that doesn’t control for confounders.

AirPlant

It occurs to me as well that even if we did develop a miracle pill that fixes low supply it would probably just end with a bunch of idiots on the internet saying that breastfeeding was beautiful and natural and the pill was just to cover up breastfeeding unfriendly policies and would turn your boob milk into formula.

Valerie

Does anybody know where the 5% number comes from? I’m trying to chase it down the rabbit hole of citations. I hit a wall with a book I don’t have access to:

I find it amusing (and horrifying) to discover that oft-cited “facts” are based on misunderstood or misrepresented research… wondering if this is the same thing.

Madtowngirl

I wonder where this number comes from, too, as I’ve heard some professionals think the incidence is more like 10-15%.

A lot of “facts” are pulled off of old data, as well. One of my doctors pointed out that the idea that it’s harder to conceive after 35 comes from a study from over 200 years ago. I wish I remembered which study she was referring to.

where they said that mothers often stop breastfeeding because they think the baby isn’t getting enough, but this can’t be right because “… studies examining milk intake and infant weight gain in exclusively breastfed infants have demonstrated that less than 5% of mothers are actually unable to produce adequate milk to meet their infant’s nutritional needs in the first four months of life.”

They cited 4 sources. One was a review that parroted the 5% line and cited the book (cited in previous comment). One looked at how how much milk “highly motivated lactating women” produce. All 13 of them were “multiparous, nonsmoking Caucasian women of middle-to-upper socioeconomic status,” so I don’t think anything can be said from this study about the population of all mothers. One was another study polling mothers about why they stopped breastfeeding- which, again, tells us nothing about how many women across the population do not actually produce enough milk. And the last one was limited to a population of 46 mothers- after half of them dropped out- and showed that even though the caloric content of some of their milk was lower than the recommended amount and the babies grew slower, the babies suffered no ill effects. In fact, they come right out and say that “These subjects were not a random or representative sample of breastfeeding mothers and their infants.”

… so, yeah, none of these sources even looked at the right things to come up with a number. It must have come from somewhere!

In short, her research found that 15% of her sample (319 women who self-selected to be in this study, ~3/4 of the original cohort) produced an insufficient amount of breastmilk, “despite prenatal preparation for breastfeeding and continuing intensive intervention,” and she judged that about 1/3 of those had a primary lactation failure (thus 5%), and the rest a secondary failure (that could not be remedied). I think one glaring problem here (for the lactivist interpretation, not the original research) is that they were only followed for 3 weeks postpartum. As in, 15% of women didn’t make enough milk… to feed a newborn, much less a 6 month old baby, exclusively.

Anyway, they might be getting 5% from somewhere else, too, but I’m pretty satisfied that it’s been taken out of context and warped beyond recognition.

Madtowngirl

So basically, if this were to be scaled up to a larger population, it would follow that we would see more like 15% of women unable to exclusively breastfeed (for any reason)? At least at the newborn stage?

Valerie

That’s what they saw in their population of 319 women, and it’s the only actual study I found where they cited their sources. Maybe there is some more data out there, but I haven’t come across it yet.

D/

The 5% claim has been around since at least 1938 along with a less mentioned benefit of successfully breastfeeding … You’ll be a saner and more sensible woman than your sister who has failed to do so.

The whole initiative is marketing, plain and simple. Breastfeeding is important to many new moms, so it makes perfect sense to choose a hospital that is credentialed for supporting breastfeeding. Of course, the whole thing is such a crock but how many people do the research to understand that?

Amy M

And any attempted internet research will simply lead to lactivist websites and ideologies.

guest

Oh, I don’t know. It seems to me the primary goal of the BFHI initiative was to reduce hospital costs by being able to stop stocking so much formula and closer nurseries. I’d need to see their budget numbers to determine whether or not they were successful at that!

Anne Catherine

I have a nurse friend who said that going baby friendly actually cost the hospital quite a bit of money –They actually didn’t pay for formula before the BHFI–the pharmaceutical companies provided it (along with the gift bags)–Now they were going to have to buy formula for those slacker bottle feeding mothers/babies.

Roadstergal

Imagine if all that money were spent on a program to give CNMs and RNs stocked vans to make prenatal and well-child visits to disenfranchised communities, restocking preventive medicine and bringing vaccination and other care.

Sarah

Nah. We couldn’t have that.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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